Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore.
Med Teach. 2022 Sep;44(9):997-1006. doi: 10.1080/0142159X.2022.2054693. Epub 2022 Jun 2.
Communication skills training (CST) remains poorly represented and prioritised in medical schools despite its importance. A systematic scoping review (SSR) of CST is proposed to better appreciate current variability in their structure, content, and assessment. This is to guide their future design in medical school curricula.
The Systematic Evidence-Based Approach (SEBA) was used to guide concurrent SSRs of teaching and assessment in CST. After independent database searches, concurrent thematic and content analysis of included articles were conducted separately. Resultant themes/categories were combined via the jigsaw perspective to provide a more holistic view of the data. These were then compared to tabulated summaries of the included articles to create funnelled domains.
52,300 papers were identified, 150 full-text articles included, and four funnelled domains were identified: Indications, Design, Assessment, and Barriers and Enablers of CST. CSTs confer numerous benefits to physicians and patients. It saw increased confidence, improved diagnostic capabilities and better clinical management, as well as greater patient satisfaction and treatment compliance. Skills may be divided into core, prerequisite competencies, and advanced skills pertinent to more challenging and nuanced scenarios - such as population or setting-specific situations. CST teaching and assessment modalities were found to align with Miller's Pyramid, with didactic teaching gradually infused with experiential approaches to enhance their understanding and integration. A plethora of CST frameworks, teaching and assessment methods were identified and are presented together.
While variable in approach, content and assessment, CST in medical schools often employ stage-based curricula to instil competency-based topics of increasing complexity throughout medical school education. This process builds on the application of prior knowledge and skills, influencing practice and, potentially, the students' professional identity formation. In addition, the institution plays a critical role in overseeing training, ensuring longitudinal guidance and holistic assessments of the students' progress.
尽管沟通技巧培训（CST）非常重要，但它在医学院中的代表性和优先级仍然很差。建议进行系统的范围审查（SSR），以更好地了解其结构、内容和评估的当前差异。这是为了指导他们在医学院课程中的未来设计。
使用系统循证方法（SEBA）来指导 CST 教学和评估的同时 SSR。在独立的数据库搜索之后，分别对纳入的文章进行主题和内容的并行分析。得出的主题/类别通过拼图视角结合在一起，以提供对数据的更全面视图。然后将它们与纳入的文章的表格摘要进行比较，以创建漏斗域。
确定了 52300 篇论文，包括 150 篇全文文章，并确定了四个漏斗域：适应症、设计、评估以及 CST 的障碍和促进因素。CST 为医生和患者带来了许多好处。它提高了医生的信心，改善了诊断能力和临床管理能力，以及患者的满意度和治疗依从性。技能可以分为核心、前提能力和与更具挑战性和细微差别场景相关的高级技能，例如特定人群或环境的情况。发现 CST 教学和评估模式与 Miller 的金字塔相吻合，随着经验方法的逐渐融入，教学逐渐增强了对技能的理解和整合。确定了大量的 CST 框架、教学和评估方法，并将它们一起呈现。
尽管在方法、内容和评估方面存在差异，但医学院中的 CST 通常采用基于阶段的课程，在整个医学教育中逐步灌输基于能力的主题，这些主题的复杂性逐渐增加。这个过程建立在应用先前知识和技能的基础上，影响实践，并可能影响学生的专业身份形成。此外，该机构在监督培训方面发挥着关键作用，确保对学生的进步进行纵向指导和全面评估。
